Director, Compliance(Preferred Experience In Health Plan Operations And Live In

Job Summary: The Director, Compliance is responsible for establishing a baseline of compliance risk, identifying areas of potential exposure, developing and aligning compliance risk management strategies with CareSource goals and objectives, and executing the compliance program ensuring effectiveness. Essential Functions: Serves as the program compliance officer for an assigned CareSource program and will be responsible for building and maintaining a strong relationship and goodwill with the relevant regulatory entity Assist the Chief Compliance Officer and their designees with the implementation of an effective compliance program Oversee all activities related to the assigned program’s regulatory and sub regulatory guidance and changes; Ensure timely responses to regulator requests, audit deliverables, and investigations; and ensure required changes are effectively implemented Build and maintain strong partnerships with business units and internal support functions to help ensure that all compliance requirements have been met; risk is monitored and remediated through testing/ development/ implementation and use Remain current and help drive interpretation and implementation of federal/state laws and regulations regarding Medicaid, Medicare and Marketplace requirements, as applicable, as well as general compliance and delegation oversight best practices and industry standards Provide key insights for the creation and execution of the annual compliance work plan and risk asses